Medicine use in older adults

As you get older, your body goes through many changes. These changes can affect the way your body handles medicine. The changes often affect parts of the body that are used to break down medicines, such as the liver and kidneys. As you age, these organs don’t work as well, which can cause medicines to build up to high levels or stay in the body for too long. This can cause side effects. So, you may become more sensitive to certain medicines or completely unable to take others.

The American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly known as the Beers Criteria, is a list of medicines that may be harmful to older adults. It shows which medicines have a higher risk of harmful reactions in adults over age 65. This list gives the names of medicines, their risks and their recommended use. The Beers Criteria list is a great resource for understanding the harmful effects of some medicines on older adults. However, if you aren’t sure if a medicine should be taken, contact your healthcare professional.

Anticholinergic medicines block the action of acetylcholine. Acetylcholine is a chemical messenger that helps cells talk to each other. It helps with memory, learning and concentration. Acetylcholine also helps control functions of the heart, blood vessels, airways, and urinary and digestive organs. When acetylcholine is blocked, it affects the regular functions of these organs. Anticholinergic medicines may be used to treat tremors, nausea and overactive bladder.

Anticholinergic medicines may have harmful side effects, especially in older adults. Side effects to watch for include:

• Confusion.
• Blurred vision.
• Constipation.
• Dry mouth.
• Lightheadedness.
• Loss of balance.
• Trouble urinating.

A medicine may have side effects because it interacts with another medicine, food, drinks, supplements or herbal products. Older people are twice as likely to have side effects from medicines. These effects also may be more severe in older adults.

Other factors that can affect medicine use may include nicotine use, caffeine, alcohol, your diet and any changes in your medical condition. Contact your healthcare professional if you experience any side effects.

Some common medicines that may harm older adults include:

• Antidepressants are medicines used to treat depression and anxiety conditions. Some antidepressants have strong anticholinergic effects. Some antidepressants also increase the risk of falls, constipation, dry mouth, drowsiness and changes in heart rhythm.
• Antihistamines relieve allergy or cold symptoms. They may be used as a sleep aid. Many antihistamines have strong anticholinergic effects. They can cause drowsiness and confusion. When used regularly, antihistamines may cause constipation, dry mouth and trouble urinating.
• Antiparkinson medicines are used to treat Parkinson’s disease. Some have strong anticholinergic effects. However, other medicines without anticholinergic effects are options for some people.
• Antipsychotics treat psychosis. Antipsychotics can cause drowsiness, movement disorders, uncontrollable twitches, and other side effects that can be fatal. Some antipsychotic medicines have anticholinergic effects. When taken by people with dementia, antipsychotics can increase the risk of stroke and death.
• Benzodiazepines are medicines used to treat anxiety, aid sleep, or treat muscle spasms. These medicines can cause drowsiness and loss of balance. Benzodiazepines may increase the risk of falls, fractures, and car crashes in older adults. Benzodiazepines are addictive and can be misused. Their effects can last longer in older adults. When used with opioids, benzodiazepines can cause excessive sedation, breathing trouble, coma, and death.
• Blood thinners reduce blood clots. They are used to prevent heart attack and stroke. Blood thinners include aspirin, warfarin, and others. In older adults, blood thinners increase the risk of major bleeding, slow heart rate, and a form of low blood pressure that happens when standing after sitting or lying down, called orthostatic hypotension.
• Gabapentinoids are medicines used to treat seizures and nerve pain. Gabapentinoids include gabapentin (Neurontin) and pregabalin (Lyrica). These medicines may have harmful effects on older adults, especially when combined with opioids.
• Gastrointestinal antispasmodics relieve stomach cramps and pain. These medicines have strong anticholinergic effects and often cause side effects in older adults.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are taken to relieve pain and inflammation. Long-term use of NSAIDs can cause peptic ulcer disease or bleeding from the stomach or intestine. NSAIDs also can cause confusion or dizziness. The medicine indomethacin has the most harmful effects in older adults of all NSAIDs.
• Opioids are medicines used to relieve pain. An opioid called meperidine should be avoided in older adults. Meperidine can cause confusion and sometimes seizures. All opioids also can cause constipation, difficulties urinating, and drowsiness. Taking high doses of opioids or taking opioids with other sedating medicines such as benzodiazepines or alcohol also can decrease the body’s drive to breathe.
• Proton-pump inhibitors reduce stomach acid production and treat acid reflux and ulcers. Long-term use of proton-pump inhibitors increases the risk of severe diarrhea caused by Clostridioides difficile infection, also known as C. diff. Long-term use also increases the risk of bone loss, fractures, and vitamin B-12 deficiency.
• Skeletal muscle relaxants relieve muscle spasms. Most muscle relaxants have anticholinergic effects. They can cause drowsiness and weakness that increases the risk of falls and fractures.
• Sulfonylureas are medicines used to treat diabetes. The effects of these medicines can last longer in older adults. Sulfonylureas can cause low blood sugar levels for many hours. These medicines can increase the risk of stroke and death.

You may be prescribed certain medicines if the benefits outweigh the risks. Talk with your healthcare professional if you have any concerns or experience any side effects. Do not stop taking these medicines without talking to your healthcare professional.